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Liquid biopsy is always with you in the battle with cancer.

25/10/2026

This week alone, we’ve seen ctDNA unlock eligibility for a cancer drug, undergo FDA advisory review as a screening test, and outperform tissue biopsy on basic reliability. This final piece asks a bigger question: should it help decide who goes to surgery?

A review published this month proposes a dynamic risk-stratification framework for oligometastatic non-small cell lung cancer — built around five ctDNA sampling points across the treatment timeline, including before and after local therapy, to help guide surgical decisions.

The honest caveat: none of today’s randomized trials in this space actually use ctDNA to select, stratify, or allocate patients. This is presented explicitly as a hypothesis for prospective testing, not established practice. The building blocks already exist separately — postoperative ctDNA is an established prognostic marker in resectable lung cancer, and ctDNA kinetics during treatment already predict systemic response elsewhere. The framework’s contribution is proposing how to connect those pieces into one decision pathway.

This week we’ve seen ctDNA unlock drugs, screen for cancer, and now maybe guide surgery. Where should the line be?

“Liquid Biopsy-Guided Surgical Decision-Making in Oligometastatic Non-Small Cell Lung Cancer: Toward Dynamic Risk Stratification in the Multidisciplinary Era.” Cancers 2026, 18(20), 3338.

https://www.mdpi.com/2072-6694/18/20/3338

23/10/2026

Sometimes the advantage of liquid biopsy isn’t about finding something tissue biopsy misses. It’s about the test actually working in the first place.

In a study of high-risk, localized prostate cancer, researchers compared tissue- and plasma-based genomic profiling head-to-head in a phase 2 neoadjuvant trial. Only 54.5% of tissue biopsy samples (12 of 22) yielded usable genomic data, mostly due to insufficient DNA quality or quantity. Every single plasma sample (27 of 27) was successfully sequenced, despite the known challenge of low cDNA levels in localized disease. When sequencing succeeded, both approaches found a similar average of 3.5 genomic alterations per sample.

It’s a small study, and larger validation is needed. But it’s a reminder that “liquid biopsy vs. tissue biopsy” isn’t always about which one detects more, sometimes it’s about which one actually gives you a result.

“Liquid biopsy vs. tissue biopsy” usually gets framed as an accuracy question. Should reliability, does the test even work, get more attention in that debate?

📚E Bettoni F, Coser EM, dos Santos EX, et al. “Liquid-based genomic profiling in high-risk localized prostate cancer.” Frontiers in Urology, 2026;6:1789586.

https://www.frontiersin.org/journals/urology/articles/10.3389/fruro.2026.1789586/full

22/10/2026

Another week, another example of a blood test directly deciding who gets a specific drug.

On October 8, Guardant Health announced European approval of Guardant360 CDx as the companion diagnostic for AstraZeneca’s camizestrant (Etcamah) in ER-positive, HER2-negative advanced breast cancer, following earlier approvals of the same pairing in the US and Japan. The test identifies ESR1 mutations, which can emerge during treatment, making repeat tissue biopsy impractical. A simple blood draw catches the mutation ahead of disease progression.

This is the 31st companion diagnostic approval for this single liquid biopsy assay, and the 3rd specifically for camizestrant across the US, Japan, and EU.

31 companion diagnostic approvals for one assay. Does a number like that surprise you, or does it match what you’re already seeing in practice?

📚Guardant Health press release, “Guardant Health Announces Approval in Europe of Guardant360 CDx as Companion Diagnostic for AstraZeneca’s ЕТСАМАН (camizestrant) in Advanced ER-positive Breast Cancer,” October 8, 2026.

https://investors.guardanthealth.com/press-releases/press-releases/2026/Guardant-Health-Announces-Approval-in-Europe-of-Guardant360-CDx-as-Companion-Diagnostic-for-AstraZenecas-ETCAMAH-camizestrant-in-Advanced-ER-positive-Breast-Cancer/default.aspx

21/10/2026

An FDA advisory panel did something no expert committee had done before this September: it formally reviewed a multi-cancer screening blood test and voted on it.

The panel voted unanimously that GRAIL’s Galleri test is safe.
But on effectiveness, the vote was 6-4. And on whether benefits outweigh risks, 7-2 with one abstention. The clinical foundation is substantial, the PATHFINDER 2 trial enrolled nearly 36,000 adults and found Galleri increased cancer detection 6.5-fold when added to standard screening.
But a panel vote isn’t an approval. The FDA’s own decision, which would be the first for any multi-cancer screening blood test, is still pending.

Unanimous on safety, 6-4 on effectiveness. Would that split change whether you’d want this test, or does the sheer scale of the trial behind it settle it for you?

Source: FDA Advisory Panel Votes to Approve GRAIL Galleri
MCED Screening Test.” Oncology Nursing News, September 27, 2026.

https://Inkd.in/e8scd3n2

PrecisionOncology Oncology

19/10/2026

CRISPR is best known as a gene-editing tool. This month, researchers proposed using it as a detection tool instead.

A new framework combines CRISPR-Cas13a, engineered to directly detect cancer-specific fusion transcripts like EWSR1-FLI1, with AI-driven analysis, aimed at point-of-care sarcoma detection. Sarcomas have historically been an underserved cancer type for liquid biopsy, but the evidence base is growing: ctDNA is already established as an independent prognostic marker, and dynamic monitoring can flag relapse months before imaging would.

It’s early-stage work, but a reminder that the next liquid biopsy breakthrough might borrow tools from a completely different part of the molecular biology toolkit.

CRISPR started as a gene-editing story. Now it’s showing up as a detection tool too. What other tools from outside oncology do you think could end up reshaping liquid biopsy next?

📚“CRISPR-Powered Liquid Biopsy Meets Artificial Intelligence: An Integrated Framework for Next-Generation Point-of-Care Sarcoma Detection.” Applied Sciences 2026, 16(20), 10309.
https://doi.org/10.3390/app162010309

14/10/2026

The liquid biopsy market is projected to nearly double by 2030, from $8.14 billion in 2025 to $15.1 billion, a 13.2% annual growth rate, according to a market report released this month.

Growth is being driven by expanding adoption of precision medicine and targeted/immune therapies, advances in biomarker discovery and sequencing, and, explicitly flagged in the report, Al’s growing role in analysis and interpretation.
Liquid biopsy is also increasingly used in clinical research, biomarker discovery, patient stratification, and drug development, not just diagnosis.

But the number only tells part of the story. This week alone, we’ve looked at liquid biopsy expanding past its original definition: immune-cell profiling instead of tumor DNA, bile instead of blood, exosomes instead of cDNA fragments.

The field isn’t just getting bigger. It’s getting wider.

Of everything liquid biopsy could test for next, what would change the most lives?

📚 “Liquid Biopsy Market to Reach US$15.1 Billion by 2030 at 13.2% CAGR, Driven by Early Cancer Detection and Precision Medicine.” GlobeNewswire, October 8, 2026.

https://Inkd.in/etJ5yTJA

13/10/2026

Circulating tumor DNA gets most of the attention in liquid biopsy for molecular residual disease. But it isn’t the only signal cells release into the blood.

A study published this spring in Molecular Cancer, the CLEAR study, developed a 5-miRNA exosome panel to detect MRD in stage Il and Ill colorectal cancer, tested across cohorts of 88 and 87 patients respectively. The panel robustly detected MRD in both stages, and the researchers combined it with tumor T-factor and stage into a single “CLEAR score” aimed at helping decide which patients should receive adjuvant chemotherapy.

It’s a reminder that “liquid biopsy” is really a category, not a single test, and the next meaningful signal might not be DNA-based at all.

cDNA, exosomes, immune profiling, bile cfDNA, the signal keeps diversifying. Which of these do you think will reach routine clinical use first?

Source: “An exosome-based liquid biopsy to predict molecular residual disease for the identification of high-risk patients with stage |I-III colorectal cancer: the CLEAR study.” Molecular Cancer, 2026.

https://Inkd.in/e6NWuez5

Oncology PrecisionMedicine

12/10/2026

Liquid biopsy research is still mostly a blood story. But for biliary tract cancers, some of the hardest cancers to detect early, blood may not be the best fluid to test.

A scoping review published this month in Cancers makes the case for bile as the liquid biopsy medium instead. Because bile sits in direct contact with tumors growing in the bile ducts, bile cell-free DNA offers real analytic advantages over plasma for detecting and profiling biliary malignancy, including higher concordance with the tumor’s actual mutations.

There’s also a practical upside: bile cfDNA is stable for hours at room temperature and for weeks when refrigerated with the right preservative, and it’s collectible during a procedure these patients are often already having, ERCP or biliary drainage, with no extra invasive step required.

Sometimes the innovation isn’t a better test. It’s testing a different fluid entirely.

If bile outperforms plasma for biliary tract cancers, which other cancers might have a better-than-blood fluid we haven’t fully explored yet?

Source: “Bile Cell-Free DNA as a Liquid Biopsy for Biliary Tract Malignancies: A Scoping Review.” Cancers 2026, 18(20), 3251.

https://Inkd.in/eg3hQV88

11/10/2026

Not everyone benefits from the same treatment after surgery.

A study published this May gives a clearer picture of who’s unlikely to need adjuvant therapy at all in non-small cell lung cancer.

Researchers tracked ctDNA-based minimal residual disease
(MRD) after curative resection and found MRD-positive status was strongly associated with shorter disease-free survival (hazard ratio: 12.0), independent of disease stage or other risk factors.

But here’s the more striking finding: among MRD-negative patients, there was no significant survival difference between those who received adjuvant therapy and those who didn’t.

This held true across high-risk stage IB patients, EGFR-mutant patients, and EGFR/ALK wild-type patients alike.
Patients whose cDNA cleared during adjuvant therapy also had meaningfully better outcomes than those whose cDNA persisted, supporting MRD monitoring as a way to see whether treatment is actually working, not just who’s high-risk.

This is observational data, not a randomized trial. But it’s a strong rationale for de-escalation trials. Would you want to be spared treatment based on a blood test alone?

Source: Journal of Clinical Oncology Precision Oncology, May 2026,

https://Inkd.in/e3ЕShjpH

AdjuvantTherapy

09/10/2026

Most liquid biopsies look for tumor DNA in the blood. This one looks at something different: whether your immune system is actually fighting.

Researchers at Vanderbilt-Ingram Cancer Center ran RNA sequencing on 546 blood samples from patients with high-risk, HER2-negative breast cancer during treatment with chemotherapy alone or combined with pembrolizumab. Early on-treatment T-cell clonal expansion and activation distinguished responders from non-responders, while non-responders and chemo-only patients showed no comparable immune shift.

Validation is still needed before this becomes a standard lab test. But it’s a reminder that “liquid biopsy” isn’t one test — it’s a whole category of ways to listen to what’s happening in the blood. Tumor DNA is just one of them.

📚https://live-vumc-reporter.pantheonsite.io/2026/04/22/liquid-biopsy-breast-cancer-immunotherapy/

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